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General NPI Number Information
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NPI Number | 1427522119
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Entity Type | Organization
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Legal Business Name | LISA N HUBBARD, PHD, LLC
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 5410 E COUNTY HIGHWAY 30A STE 205
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-6589
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Country | US
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Telephone | 850-889-8869
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Fax | 850-296-8111
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Provider Business Mailing Address
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Address Line | 5410 E COUNTY HIGHWAY 30A STE 205
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-6589
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Country | US
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Telephone | 850-889-8869
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Fax | 850-296-8111
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Authorized Official
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Title or Position | LMHC
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Name | DR. LISA N HUBBARD
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Credential | DR.
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Telephone | 850-889-8896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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